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Substance Abuse Treatment for Prescription Painkiller Abuse

Abuse of prescription painkillers is one of the most alarming and rapidly growing trends in the U.S. According to the CDC, 1 in 20 people in the U.S. admit to using prescription painkillers for non-medical use over the past year. There are approximately 40 U.S. deaths per day due to prescription painkiller abuse. With these troubling trends, understanding substance abuse treatment for prescription painkiller abuse is more important than ever.

Being addicted to opiates is not a mental or moral weakness. It is a chronic medical condition that can result from brain chemistry changes in people who are susceptible to addiction. Once painkiller addiction has developed, escaping the cycle of addiction and relapse is usually a long-term process requiring external help from substance abuse treatment professionals.

Unfortunately, breaking free from painkiller addiction takes much more than mere willpower. However, there are a number of different medications, treatments, and therapies that can improve the odds of success.

Physical Dependence

Opioid addiction changes the way certain neural pathways work in the brain, and alters brain circuitry responsible for “reward” behavior and mood. These neural changes result in powerful addiction, and intensive substance abuse treatment is usually necessary. There are six recognized characteristics of opioid dependence as established by the World Health Organization (WHO):

1. A strong desire or feeling of compulsion to take the drug.

2. Difficulty controlling drug-taking behavior.

3. A physiological withdrawal state that results when drug use is reduced or stopped entirely.

4. Tolerance to the drug such that increased doses are required to achieve the same effects.

5. Increasing neglect of other pleasures or interests in favor of opioid use.

6. Continued use of the drug despite clear evidence of harm to self.

Withdrawal and Detoxification

Once a person is dependent on a drug, cutting off the supply will result in withdrawal symptoms that can affect virtually all systems in the body. Managing withdrawal symptoms is a central aspect of substance abuse treatment. Withdrawal symptoms can include:

  • Craving for drugs
  • Dilated pupils
  • Agitation
  • Anxiety
  • Runny nose
  • Insomnia
  • Sweating
  • Diarrhea
  • Goosebumps
  • Abdominal Cramping
  • Vomiting
  • Body aches

But for someone with an advanced painkiller addiction, this list of symptoms doesn’t come close to capturing the full agony of withdrawal. The symptoms can last for hours to days to weeks—depending on how the drug use has lasted—and are so unpleasant that a person will do almost anything to avoid them. That’s why a central part of substance abuse treatment for prescription painkiller abuse involves management of withdrawal symptoms: if symptoms can be effectively minimized, it helps the patient to detox and stop being physically dependent on the drug.

Medications for Opioid Withdrawal

There are a number of different medications that can be used in substance abuse treatment programs to prevent and manage opioid withdrawal during the detoxification process.

Methadone is a long-acting opioid drug. It is sometimes explained as a non-addictive opioid.  It interacts with the same opioid receptors as prescription painkillers, neutralizing withdrawal symptoms. Providing a patient with the proper dose of methadone eases drug craving and prevents withdrawal symptoms but does not produce euphoria. As a patient’s treatment progresses, the dose can be slowly tapered off, freeing the patient from physical dependence without opioid withdrawal symptoms.

Buprenorphine is newer drug that works in a similar way to methadone. It is typically combined with subutex for the first few days of treatment. It can be very effective if used properly.

Clonidine is a medication for blood pressure medicine that works on the brain. The drug effectively reduces the “fight or flight” response, which over activates during opioid withdrawal. However, clonidine does not reduce drug craving, and should thus be combined with other medications for full effectiveness

Avoid “Rapid Detox” Programs

These substance abuse treatment programs claim to speed up the detox process by giving larger doses of opioid-blocking drugs. Some even place a patient under general anesthesia during the detox process. This can present a health risk to the patient: heavy doses of opioid-blocking drugs can be just as bad as overdoses of opioids. Besides being dangerous, these programs have not proven to be more effective than traditional substance abuse treatment.

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